Originally described in 1901, laparoscopy was used by gynecologists
as a surgical approach throughout most of the 20th century. Its applicability
to general surgery was popularized in 1987 when laparoscopic cholecystectomy
was first performed.1 Subsequently, minimal-access
approaches have been used by general surgeons for multiple intra-abdominal
operations because of perceived reductions in patient discomfort and disability,
shorter hospital stays, and more rapid return to work.2
Now the term minimally invasive surgery encompasses several variations on
the purely laparoscopic approach. This general term can mean several different
things including a pure laparoscopic approach (all incisions ≤1 cm), a
hand-assisted approach in which access large enough to accommodate the surgeon's
hand is made to facilitate the procedure (largest incision, 6-8 cm), or a
laparoscopic-assisted procedure, some of which is performed in the traditional
open fashion (largest incision >4 cm). The approach used is based upon the
training, experience, and skills of the surgeon as well as the pathologic
process being treated.